In 2006, Ethiopia legalized abortion for minors, women whose health was threatened, victims of rape and several more indications. Although the law is one of the most liberal in Africa and has already saved lives, many Ethiopian women remain confused or unsure of their rights and don't know how to prevent unplanned pregnancies. In a 23 minute documentary produced in association with Ipas (viewable here), filmmaker Lisa Russell spends time with a woman who lost her daughter to an illegal abortion, a local medicine man who claims his mixtures are more effective than the modern clinic and a mother named Asnaketch who induced multiple abortions in her youth and now seeks to educate girls. But most movingly she follows two young girls, Tigish and Belynash, as they go to a clinic and then a hospital to avail themselves of their new right. A deeply moving viewing experience, Not Yet Rain paints a clear picture of the value of legal abortion while also making clear that just legalizing abortion does not go far enough to guarantee women's health and rights. Russell spoke to RH Reality Check about the process of making the film and what she hopes will result from it.

First of all, what led you to choose this specific subtopic for the film and how did you go about researching? Did you know that Ethiopia had recently changed its laws and that you wanted to set a film there?

I have a background in public health and got into filmmaking secondarily. In 2004, I did a film on obstetric fistula, which is an issue that not too many people had heard about. Because of that experience of seeing how powerful film can be in getting people to talk about something as difficult as obstetric fistula, I wanted to pursue another issue that was not getting enough attention--and that was unsafe abortion. I was co-presenting with Ipas at a conference and we realized we had similar goals. We chose Ethiopia because we also wanted to make a film that had a positive message that showed some progress being made. The law was so new there so we knew there would be some instances where women didn't have the information or access that they needed, and there would also be stories about women who were able to successfully access services, so we could get a good look at the possibilities and also the challenges.

I found the film very moving and compelling, partly due to the people in it, partly the  music and style. You did it in a very artistic way. Can you tell me a bit about the stylistic choices you made?
In all my films everyone mentions the music because it's such an important part of the films. I feel that it's a difficult story, but these are beautiful women and a beautiful country so why not expose that as well? I was brought up under the training that said the greatest documentaries made illustrate and don't tell. The best way to do that is to show women as human beings.

The women in the film who were seeking abortions had been raped. What is the connection you saw between sexual violence and the need for abortion?

I've seen the connection with sexual violence with every single women's health issue that I've covered. Unwanted pregnancies can be cause by a lot of things. One of the biggest things is the incidence of rape. A woman with an unwanted pregnancy due to rape gets stigmatized twice. That's why providing access to safe and legal service is so important, because women in that stigmatized position will go to desperate means.

Seeing the connection between the need for reproductive health services and sexual violence, does it frustrate you that aid for the latter is politicized?

Women are dying because they don't have access to care. What's unfortunate too is that because of politics about abortion we've exported our controversies with policies like the global gag rule, and the de-funding of UNFPA.  Programs and support are affected because of the politics surrounding abortion. Stigma is one of the most pressing barriers.  I was shooting the fistula film in Niger, and I asked about unsafe abortion which is illegal in Niger. They said it's really unfortunate, but if a woman has tried to self abort and needs post-abortion care she can be turned away because of the stigma. It's a genuine public health problem and human rights issue. Women are dying. They are presenting themselves in need of emergency care and being turned away.

There was also an emphasis in the film on how little knowledge many young women have about family planning as well as the new abortion law. Is that changing?

A couple of organizations I talked to were deeply affected by the global gag rule. I shot the film in 2008 before the election before global gag was overturned and people were witnessing a decrease in family planning because of funding issues. Now [that President Obama overturned the gag rule] there is a commitment and interest in getting the information out there. It's relatively new, this abortion law. Ipas is doing a great job working with local community groups, getting information about safe abortion services as well as contraception and contraceptives out there.

There is new training happening for midwives, to get them trained not only in terms of the MVA (manual vacuum aspiration) procedure but also with information about contraception.

The film highlighted Asnaketch's young son, who talked about the need for women's empowerment. Was his enlightenment just a result of his mother being so extraordinary or being a member of a younger generation?

I think it has to do with both. It's because he's young, and more importantly educated -- in the film, he was walking out of a school during the scene where she's holding his hand. So he had the combination of being an educated young man, and also his mother was very open and very clear about her experiences. If young people get access to education they are more likely to have more progressive views of the rights of women and young girls.

Is there the same stigma facing doctors who provide abortion in Ethiopia? Are they targeted or shunned the way they sometimes are in the US?

I didn't see [the doctors] outside of the hospital setting, so I didn't know about their personal lives. But I did notice that one of midwives was wearing a cross. I asked, "Does this conflict with your religious beliefs?" He said, "I have seen many women, even some of my sisters face these challenges." [The doctors] are the ones who see women dying and that impacts how they feel and their commitment. The doctor in the film is one of 3 ob/gyns for a population of five million. He sleeps at the hospital; he hasn't had a vacation in 8 years. He told me he once saw a woman who had been in labor for five days.  Our generation and those close to mine have forgotten what it was like when abortion wasn't legal. When you're faced with that there's a different perspective and commitment level.

Was the shoot emotionally difficult?

When I was in the hospital room with Belynash, and her hands were over her eyes my battery died. And in the end I was glad it did. It was an intense moment.  Here were two young girls who have never been to a doctor getting an exam in front of several strangers. And there was Tigist whose mother died in childbirth who thought she might not live through the operation. The doctor did a good job counseling them and telling them what was going to happen but Tigist was yelling and screaming. Also I realized that this was due to a rape incident so she was going through the trauma twice. Then our translator who was trying to be a mother figure to both almost fainted on the floor. I felt sadness, and rage. 

And then there was Aster, who for a good hour was just crying and talking about how her daughter died from a botched abortion.  Fifteen years later this mother is still feeling partly responsible. Her daughter lied about what happened and her mom took her from clinic to hospital, clinic to hospital. She was reminiscing about something which happened 14 years ago, but it was just heartbreaking. They were such incredible women.

Do you think what's happening in Ethiopia is likely in any way to affect her neighbors or other countries to have a more humane policy?

I don't know the statistics, but I do think South Africa [which has legalized abortion but still struggles with deaths from illegal abortions] and Ethiopia are going to be looked at. Maternal mortality is a very real and tragic reality in developing countries. If this really does decrease the number of women dying people will pay attention, because it's that bad.

What has the response been like to the film so far?

When people first hear that there's a film about unsafe abortion it's sort of like "is that something I can stomach"? But people feel something when they watch this. It has a story to tell and it showcases women. There was a screening at Cornell and there's one planned at USC. People are starting to watch it and forward it around. In terms of outreach and who we want to reach, we have high hopes for it. Getting other people to feel like they take ownership of it, that's the first step.